A medical student asked to speak to me about a month ago at the Philadelphia College of Osteopathic Medicine, where I am an Instructor of family medicine. He has been very active in our school’s Primary Care Scholars program and community health outreach activities. “Dr. Chan,” he said, “I am so torn. I really love primary care, but I am so worried that I won’t be able to get my ...

Last August, the American Academy of Pediatrics (AAP) issued a statement regarding school start times, really a plea to all middle and high schools to start the school day no earlier than 8:30 a.m.
The statement emerged as a result of accumulating evidence showing that earlier school start times effectively restrict an adolescent’s ability to get regular healthful sleep.
The timing of the AAP’s statement came on the heels of another sentinel event ...

A new study about physical activity, obesity, and mortality has been propagating so many headlines and so much commentary, it's pretty much a given that if you are seeing this, you have seen something like: "Inactivity kills more than obesity."
As is generally true in such cases, few of the people opining about the study seem to have actually read it. I suppose that's understandable -- once you get to particulars ...

Mr. Dwyer isn't my patient, but today I'm covering for my partner in our family practice office, so he's been slipped into my schedule.
Reading his chart, I have an ominous feeling that this visit won't be simple.
A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath.
He suffers from both congestive heart failure and renal ...

Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast. She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer. This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast ...

When babies are born prematurely, they often lack surfactant: a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive ...

Her heart was failing; her ejection fraction was unmeasurable. Her hip was broken, and she developed a pulmonary embolism post-operatively. She was painfully close to death. Yet at some point, the hospital finished and spit her out at the nursing home.
She was confused.
I tried to take the best history that I could. Her answers where usually no more than a single word. Her physical exam revealed a desperately weak woman, ...

As part of the increasing push for health care quality improvement, a lot of energy is being focused on improving our communication with patients and making sure that patient-centered care is more than just a buzz phrase. Gone are the days when the doctor-patient interaction was a wholly paternalistic one, where the doctor’s word was taken as final and absolute, and patients weren’t encouraged ...

Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that?
Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren ...

We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at least not worsen. Intellectually, we know we’ll not be ...

Patients admitted to the hospital ward sometimes get sicker instead of getting better right away. Often this can happen acutely. Depending on the circumstances, ranging from a "rapid response" for unstable vital signs to a cardiac arrest (a "code”), previously uninvolved hospital staff might be called on to help. Despite the commotion, these events are a period of time for the health care team to shine. At inpatient emergencies, ...

You live like this, sheltered, in a delicate world, and you believe you are living ... And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death.
- Anais Nin
On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation. About 50 meters in ...

This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift.
Fresh out of residency, I had accepted a job in the ER of a community hospital which -- though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview -- had turned into exactly the opposite when I was slugging through the night shifts alone and disgruntled ...

I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings.
Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why ...

This isn’t a debate about vaccines.
The fight here has nothing to do with that. For the record, I strongly support the concept of vaccination. Public health is better in the 21st century because of it. Measles? Mumps? Oh, I can find you in the United States, but we aren’t living our lives every day petrified of an outbreak. Smallpox? Polio? Where did you go? Not here, that’s for sure. And, ...

This week the local and national attention has been riveted on accusations that Bill Belichick and the Patriots football team deliberately deflated the footballs used in the division championship game. Football, remember, is a multi-billion dollar industry in which the commodity being sold is grown men throwing brown, oblong balls at each other and knocking each other down. Boston.com, a ...

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
In an emergency, the first question people often ask is: “Is there a doctor in the house?” When you have a medical problem, the best advice is, “Ask your doctor.” Most people automatically assume that “doctor” in this context refers to a physician with a ...